Association of low diastolic blood pressure with cardiovascular outcomes and all-cause mortality: A meta-analysis

Abstract

BackgroundReduction of diastolic blood pressure (DBP) below 70 mmHg may decrease perfusion to the heart and worsen cardiovascular (CV) outcomes. AimsExplore the association between low DBP and CV outcomes. MethodsWe searched the online databases until August 2023 for studies reporting the risk of all-cause mortality (ACM) or CV outcomes in patients with low versus normal DBP (70–80mm Hg). ResultsInclusion of 10 studies (n = 1,998,223 patients) found that a mean achieved DBP < 60 mmHg was associated with an increased risk of all-cause mortality (HR 1.48; 95 % CI [1.26–1.74]), especially in patients with pre-existing CV disease. It was also associated to a higher risk of major adverse cardiovascular events (HR 1.84; [1.28-2.65]) and myocardial infarction (HR 1.49; [1.13-1.97]). A DBP of 60–69 mmHg was associated with an increased risk of all-cause mortality (HR 1.11; [1.03–1.20]). ConclusionReduction of DBP, particularly below 60 mmHg, is associated with increased risk of ACM.